Madison Medical Center

All Charges

Charge

Type

Setting

Price

FX CLOSED FINGER

Facility

$350.00

Service Code	CPT 26720
Hospital Charge Code	9826720
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

FX CLOSED FINGER WITH MANIPULATION

Facility

$350.00

Service Code	CPT 26725
Hospital Charge Code	9826725
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

FX CLOSED FINGER WITH MANIPULATION

Facility

$350.00

Service Code	CPT 26725
Hospital Charge Code	9826725
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED HUMERAL W/O MANI

Facility

$955.00

Service Code	CPT 24530
Hospital Charge Code	9824530
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$681.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$565.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$681.87
Rate for Payer: Cash Price	$859.50
Rate for Payer: Cash Price	$859.50
Rate for Payer: Cash Price	$859.50
Rate for Payer: Cash Price	$859.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$636.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED HUMERAL W/O MANI

Facility

$955.00

Service Code	CPT 24530
Hospital Charge Code	9824530
Hospital Revenue Code	521
Rate for Payer: Cash Price	$859.50

FX CLOSED RADIAL/ULNAR W/O MANIPULATION

Facility

$750.00

Service Code	CPT 25560
Hospital Charge Code	4225560
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$444.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$535.50
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$500.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED RADIAL/ULNAR W/O MANIPULATION

Facility

$750.00

Service Code	CPT 25560
Hospital Charge Code	4225560
Hospital Revenue Code	521
Rate for Payer: Cash Price	$675.00

FX CLOSED TIBIA

Facility

$1,200.00

Service Code	CPT 27530
Hospital Charge Code	9827530
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,080.00

FX CLOSED TIBIA

Facility

$1,200.00

Service Code	CPT 27530
Hospital Charge Code	9827530
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$856.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$710.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$856.80
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$800.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TREATEMENT RADIUS W/O MANIPULA

Facility

$800.00

Service Code	CPT 25600
Hospital Charge Code	9825600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$571.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$473.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$571.20
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$533.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TREATEMENT RADIUS W/O MANIPULA

Facility

$800.00

Service Code	CPT 25600
Hospital Charge Code	9825600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$720.00

FX CLOSED TRTMT METATARSAL W/O MANIPULAT

Facility

$600.00

Service Code	CPT 28470
Hospital Charge Code	9828470
Hospital Revenue Code	521
Rate for Payer: Cash Price	$540.00

FX CLOSED TRTMT METATARSAL W/O MANIPULAT

Facility

$600.00

Service Code	CPT 28470
Hospital Charge Code	9828470
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$355.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$428.40
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$400.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TX DIST FIB FX W/O MANIPULATIO

Facility

$1,000.00

Service Code	CPT 27786
Hospital Charge Code	9827786
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$714.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$592.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$714.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$667.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TX DIST FIB FX W/O MANIPULATIO

Facility

$1,000.00

Service Code	CPT 27786
Hospital Charge Code	9827786
Hospital Revenue Code	521
Rate for Payer: Cash Price	$900.00

FX CLOSED TX METACARPAL

Facility

$720.00

Service Code	CPT 26600
Hospital Charge Code	9826600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$514.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$426.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$514.08
Rate for Payer: Cash Price	$648.00
Rate for Payer: Cash Price	$648.00
Rate for Payer: Cash Price	$648.00
Rate for Payer: Cash Price	$648.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$480.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TX METACARPAL

Facility

$720.00

Service Code	CPT 26600
Hospital Charge Code	9826600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$648.00

FX CLOSED TX METACRAPAL FX W/O MANIPULAT

Facility

$750.00

Service Code	CPT 26600
Hospital Charge Code	4226600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$675.00

FX CLOSED TX METACRAPAL FX W/O MANIPULAT

Facility

$750.00

Service Code	CPT 26600
Hospital Charge Code	4226600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$444.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$535.50
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$500.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TX PHALANGEAL SHAFT FX CAST

Facility

$300.00

Service Code	CPT 26720
Hospital Charge Code	4426720
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

FX CLOSED TX PHALANGEAL SHAFT FX CAST

Facility

$300.00

Service Code	CPT 26720
Hospital Charge Code	4426720
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX CLOSED TX TOE

Facility

$263.00

Service Code	CPT 28510
Hospital Charge Code	9828510
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

FX CLOSED TX TOE

Facility

$263.00

Service Code	CPT 28510
Hospital Charge Code	9828510
Hospital Revenue Code	521
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX COLLES TYPE; CLOSED NO MANIPULATION

Facility

$750.00

Service Code	CPT 25600
Hospital Charge Code	4125600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$444.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$535.50
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$500.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

FX COLLES TYPE; CLOSED NO MANIPULATION

Facility

$750.00

Service Code	CPT 25600
Hospital Charge Code	4125600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$675.00

Know your out-of-pocket cost for care.

All Charges